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ACC Programme 2022

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Prehabilitation: Evidence and Practice

16 Nov 2022
ACC Theatre A
Dr Sandy Jack, Professor of Prehabilitation Medicine, University of Southampton and Honorary Consultant Clinician Scientist, University Hospital Southampton NHS Foundation Trust Physical fitness, healthy diet and psychological well-being are associated with better postoperative outcomes. Prehabilitation aims to improve physical, psychological and nutritional fitness thereby increasing resilience. We have shown the harmful effects of cancer treatments on fitness, quality of life and perioperative outcome. We have demonstrated (10 trials; 1,466 patients) benefits of prehabilitation; and that individualised, supervised high intensity exercise programme, improves physical fitness, quality of life and mitochondrial function. There is an urgent need to develop a core outcome set, including validation of screening and assessment tools, to enable implementation of stepped care model needs-based approach as standard care. References West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, Grocott MP, Jack S. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015 Feb;114(2):244-51. doi: 10.1093/bja/aeu318. Epub 2014 Oct 1. PMID: 25274049. Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado CM, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr. 2021 Jun 24;8:644706. doi: 10.3389/fnut.2021.644706. PMID: 34249985; PMCID: PMC8264148 Levett DZH, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia. 2019 Jan;74 Suppl 1:36-42. doi: 10.1111/anae.14507. PMID: 30604423. Huang GH, Ismail H, Murnane A, Kim P, Riedel B. Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study. Support Care Cancer.(2016) 24:2277–85. doi: 10.1007/s00520-015-3028-749 Assouline B, Cools E, Schorer R, Kayser B, Elia N, Licker M. Preoperative exercise training to prevent postoperative pulmonary complications in adults undergoing major surgery: a systematic review and metaanalysis with trial sequential analysis. Ann Am Thorac Soc 2021;18: 678–688 Barberan-Garcia A, Ubre M, Pascual-Argente N, Risco R, Faner J, Balust J, Lacy AM, Puig-Junoy J, Roca J, Martinez-Palli G. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. Br J Anaesth. 2019 Oct;123(4):450-456. doi: 10.1016/j.bja.2019.05.032. Epub 2019 Jun 25. PMID: 31248644. MA West, L Loughney, G Ambler, BD Dimitrov, JJ Kelly, MG Mythen, R Sturgess, PMA Calverley, A Kendrick, MPW Grocott and S Jack. The Effect of cancer therapies on physical fitness before oesophagogastric cancer surgery: A prospective blinded multi-center, observational cohort study. NIHR Open Research 2021 Lisa Loughney and Malcolm A West, Helen Moyses, Andrew Bates, Graham J Kemp, Lesley Hawkins, Judit Varkonyi-Sepp, Shaunna Burke, Christopher Barben, Peter M Calverley, Trevor Cox, Daniel Palmer, Monty Mythen, Michael PW Grocott and Sandy Jack. The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: a randomised controlled trial (The EMPOWER Trial) Perioperative Medicine (2021) 10:23 West MA, Astin R, Mosyses HE, Cave J, White D, Levett DZH, Bates A, Brown G, Grocott MPW, Jack S. Exercise prehabilitation may lead to augmented tumor regression following neaadjuvant chemoradiotherapy in locally advanced rectal cancer. Acta Oncol. 2019 May: 58 (5): 588-595,doi: 10.1080/0284186X.2019.156775. Epub 2019 Feb 6. PMID: 30724668. Moore J, Merchant Z, Rowlinson K, McEwan K, Evison M, Faulkner G, Sultan J, McPhee JS, Steele J. Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'. Eur J Surg Oncol. 2021 Mar;47(3 Pt A):524-532. doi: 10.1016/j.ejso.2020.04.042. Epub 2020May 1. PMID: 32439265. West MA, Loughney L, Lythgoe D, Barben CP, Adams VL, Bimson WE, Grocott MP, Jack S, Kemp GJ. The effect of neoadjuvant chemoradiotherapy on whole-body physical fitness and skeletal muscle mitochondrial oxidative phosphorylation in vivo in locally advanced rectal cancer patients--an observational pilot study. PLoS One. 2014 Dec 5;9(12):e111526. doi: 10.1371/journal.pone.0111526. PMID: 25478898; PMCID: PMC4257525.
Sandy Jack, Professor of Prehabilitation Medicine, University of Southampton - Consultant Clinician Scientist, University Hospital Southampton NHS Foundation Trust



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